Halo Traction Research Articles

Traumatic Enucleation of the Body of the Sixth Cervical Vertebra Without Neurologic Sequelae

Case report of an adult man with traumatic enucleation of the body of the sixth cervical vertebra with initial minimal neurologic damage and without vascular injury, which was successfully treated with surgery. To describe the traumatic mechanism, diagnostic procedures, operative findings, and adopted management. Literature review suggests that the observed case is exceptional. Similar vertebral injuries are usually associated with severe neurologic and vascular damages. A 38-year-old farmer with enucleation of the body of the sixth cervical vertebra was admitted to the Orthopedic Clinic of Padua University. The patient initially was treated with halo traction. Two days later, he underwent anterior open reduction and internal fixation with plate. He was discharged 2 months later with a halo vest. Two years after surgery, the pedicles' fracture had healed solidly with normal intervertebral alignment and a slight loss of the height of the C6-C7 intervertebral space (fibrous union). He is asymptomatic and has totally resumed his habitual work. Traumatic enucleation of the body of a lower cervical vertebra is a rare injury. The case presented here demonstrates that such a lesion can be less severe than a complete dislocation or a burst fracture. The good outcome of surgery suggests that the treatment adopted was effective, although an interbody fusion would have been more adherent to conventional surgical principles.

Radiologic and clinical spectrum of occipital condyle fractures: retrospective review of 107 consecutive fractures in 95 patients.

We proposed to characterize the radiologic spectrum of occipital condyle fractures in a large series of patients and to correlate fracture pathology with neurosurgical treatment and patient outcome. We conducted a retrospective review of the findings on conventional radiography, CT, and MR imaging in 95 patients with 107 occipital condyle fractures. We described fracture patterns according to two previously published classification systems. Clinical findings, neurosurgical management, and patient outcome were obtained from the medical records. Inferomedial avulsions (Anderson and Montesano type III) were the most common type of occipital condyle fracture, constituting 80 (75%) of 107 overall fractures. Unilateral occipital condyle fractures were found in 73 (77%) of 95 patients, and 58 patients were treated nonoperatively; occipitocervical fusion was required in nine patients for complex C1-C2 injuries, and six patients died. Bilateral occipital condyle fractures or occipitoatlantoaxial joint injuries were seen in 22 (23%) of 95 patients. Occipitocervical fusion or halo traction for the craniocervical junction was required in 12 patients, all of whom had CT evidence of bilateral occipitoatlantoaxial joint disruption and six of whom showed normal craniocervical relationships on conventional radiographs. Six patients with nondisplaced fractures were treated nonoperatively, and four patients died. Thirty (32%) of 95 patients showed continued disability, whereas 55 (57.5%) of 95 patients had good outcomes at 1 month. Associated cervical spine injuries were present in 29 (31%) of 95 patients. Given their associated traumatic brain and cervical spine injuries, occipital condyle fractures are markers of high-energy traumas. That conventional radiographs alone may miss up to half of the patients with acute craniocervical instability has not been well established. Avulsion fracture type and fracture displacement are associated with both injury mechanism and the need for surgical stabilization. In this series, most unilateral occipital condyle fractures were treated nonoperatively, whereas bilateral occipitoatlantoaxial joint injuries with findings of instability usually required surgical stabilization.

Posterior approach for low cervical fractures with unilateral or bilateral facet dislocation

We evaluated treatment by posterior approach and its results for unilateral and bilateral facet dislocation of the lower cervical spine. Fracture reduction and ultimate stabilization of low cervical fractures located between C3 and C7 depend on the mechanism of the lesion and the resulting affectation of the osteoligamentary structures. The varied surgical approaches to fractures with unilateral or bilateral luxation include anterior, posterior, and combined. No surgery is performed if a conservative approach is used. Of the 71 low cervical fractures treated in our service in 10 years, 42 were facetary luxations (unilateral in 24 patients and bilateral in 18). Radiological studies included X-ray, CT and, in some cases, MRI. Once cervical fracture was diagnosed, halo traction was initiated and the decision to operate (34 cases) or continue conservative treatment (eight cases) was made a week after admittance. Surgery consisted of the posterior approach (27 bilateral clamps with bone graft, 5 wires with bone graft, and two posterior plates). Average patient follow-up was 7 (range 2-12) years. The patients' neurological status improved in 30 cases (71.42%) and was unchanged in 12 (28.57%). Three of eight patients initially treated conservatively developed radicular pain and instability and underwent surgery. Clamps were placed via a posterior approach in one case and the other two cases required a combined posterior and anterior approach. No instrumentation has required removal, although one patient developed a wall abscess. We found a posterior approach provides good stability for placing an arthrodesis in patients with a unilateral or bilateral cervical dislocation. In most of our cases we used clamps, and there was no worsening of any patient's neurological condition.

Efficacy of Perioperative Halo-Gravity Traction in the Treatment of Severe Scoliosis in Children

Perioperative halo traction was used in the treatment of severe scoliosis in 19 children. Diagnoses included neuromuscular, idiopathic, and congenital scoliosis. Traction was transferable between the bed and a walker or wheelchair. Thirteen patients had prior spinal surgery, and most required osteotomy. Traction was used for 6 to 21 weeks. All patients underwent spinal fusion surgery after traction, with instrumentation used in 15 patients. Improvement was achieved in all patients. The Cobb angle improved 35% from an average 84° before traction (range 63°–100°) to 55° preceding fusion. Trunk decompensation improved in all patients. Trunk height increased 5.3 cm in traction. Response to traction did not correlate with diagnosis, patient age, or prior surgery. There were no neurologic complications. Perioperative halo-gravity traction improves trunk balance and frontal and sagittal alignment in children with severe spinal deformity. Surgical fusion was enhanced by the improved alignment, and neurologic injury was avoided.

Efficacy of perioperative halo-gravity traction in the treatment of severe scoliosis in children.

Perioperative halo traction was used in the treatment of severe scoliosis in 19 children. Diagnoses included neuromuscular, idiopathic, and congenital scoliosis. Traction was transferable between the bed and a walker or wheelchair. Thirteen patients had prior spinal surgery, and most required osteotomy. Traction was used for 6 to 21 weeks. All patients underwent spinal fusion surgery after traction, with instrumentation used in 15 patients. Improvement was achieved in all patients. The Cobb angle improved 35% from an average 84 degrees before traction (range 63 degrees -100 degrees ) to 55 degrees preceding fusion. Trunk decompensation improved in all patients. Trunk height increased 5.3 cm in traction. Response to traction did not correlate with diagnosis, patient age, or prior surgery. There were no neurologic complications. Perioperative halo-gravity traction improves trunk balance and frontal and sagittal alignment in children with severe spinal deformity. Surgical fusion was enhanced by the improved alignment, and neurologic injury was avoided.

Operative treatment of severe scoliosis in osteogenesis imperfecta: results of 20 patients after halo traction and posterior spondylodesis with instrumentation

Correction and stabilisation of the scoliotic spine in osteogenesis imperfecta is difficult. The optimal technique has yet to be determined, since no large series in which a single procedure has been carried out by a single surgeon using a single protocol has yet been described. The charts of 20 patients with osteogenesis imperfecta who had undergone halo gravity traction (HGT) and a posterior spondylodesis with Cotrel-Dubousset (n = 18) or Harrington (n = 2) instrumentation were reviewed. No correction was made at the time of the surgical spondylodesis. The average follow-up was 4.8 years (range 2-10.5 years). The preoperative traction improved the Cobb angle of the scoliosis by 32% (from a mean of 78.5 degrees to a mean of 53.3 degrees) and improved the kyphosis by 24% (from a mean of 56.0 degrees to mean of 42.5 degrees). This correction deteriorated slightly at final follow-up, for both the scoliosis and the kyphosis (mean 57.6 degrees and 44.4 degrees respectively). Few complications were encountered during the HGT period. In 16 cases no complications occurred during the follow-up period. Ambulation and functional ability were upgraded for 7 of 20 patients.

Recovery from Cruciate Paralysis Due to Axial Subluxation from Metastatic Breast Carcinoma: A Case Report.

Cruciate paralysis is an uncommon and potentially life-threatening myelopathy thought to arise from injury to the corticospinal tracts at a high cervical spinal level. The authors report on the case of a woman who developed cruciate paralysis secondary to axial subluxation of the cervical spine due to invasion by metastatic breast carcinoma. Correct bedside diagnosis, prompt spinal alignment via halo traction, and surgical spinal decompression with fusion stabilization reversed the paralysis completely. Postoperative antiestrogen medication, spinal radiation, and chemotherapy promoted local tumor control, allowing the patient longevity and good quality pain control. The prompt diagnosis and treatment of cruciate paralysis could effect a good prognosis in a seemingly terminal patient with metastatic spinal breast carcinoma by resolving life-threatening myelopathy, promoting longevity, and assisting with pain control.

Atlantoaxial Rotatory Subluxation in Patients With Marfan Syndrome

This is a retrospective case series of three patients, ages 9 1/2, 13, and 20 years old, with Marfan syndrome treated for atlantoaxial rotatory subluxation. In the first two cases, acute torticollis was noted postoperatively, following pectus excavatum repair. The diagnosis was made in the third patient after she presented to the emergency room with a week-long history of unresolved neck pain following minor trauma. To report and discuss the courses and clinical sequelae of atlantoaxial subluxation in patients with Marfan syndrome. Radiographic analysis of patients with Marfan syndrome has shown that increased atlantoaxial translation, larger odontoid height, and basilar impression are more prevalent in this population compared to age-matched controls. Despite these findings, there are sparse data on injuries secondary to cervical spine instability or abnormalities in this population. To the authors' best knowledge, no report of atlantoaxial rotatory subluxation in patients with Marfan syndrome exists in the literature. Case records of rotatory instability of the atlanto-axial level were reviewed and are presented in the following report. The first two patients described in this report were noted to have "cock robin" posturing of their necks following pectus excavatum repairs. The first patient's subluxation was partially reduced with halo traction, and he subsequently underwent posterior spinal fusion of C1-C2 with internal fixation. The patient was well aligned postoperatively, and had no neurologic deficits. The second patient's subluxation reduced after 20 days of halter and traction; he was immobilized in a collar following discharge and reduction was maintained. The third patient's subluxation failed to reduce with halo traction; further imaging studies revealed odontoid prominence in the foramen magnum. She underwent posterior spinal fusion, occiput to C3, with satisfactory result. The cervical bony and ligamentous abnormalities seen in patients with Marfan syndrome may slightly increase their risk for atlantoaxial rotatory instability. Special attention to intubation and positioning, both intraoperatively and postoperatively, may be necessary in patients with Marfan syndrome. Additionally, rotatory subluxation should be included in the differential diagnosis for Marfan patients with neck pain after injury.

Vertebral decancellation for severe scoliosis.

The results of staged surgery including vertebral decancellation were reviewed retrospectively for 21 patients with severe scoliosis. To evaluate the benefits and limitations of vertebral decancellation as new anterior surgical procedure. The curvatures of severe scoliosis are often very rigid, and surgical correction using the anterior or posterior approach may not achieve the desired correction. Some studies reported neurologic complications might appear due to the aggressive approach or excessive correction force. Twenty-one patients (average age, 17.0 years) with severe scoliosis, in whom Cobb angle was over 80 degrees (average angle, 107 degrees), underwent staged anterior and posterior spinal reconstruction. Vertebral decancellation was performed as anterior procedure, and until posterior instrumentation, halo traction was carried out. The transition of curvatures in coronal and sagittal planes was assessed in this series. The average correction rate of lateral curvature at the final follow-up was 46%. The average loss of correction was 2.5 degrees. Kyphosis, measured between T5 and T12, changed from 41 degrees to 36 degrees. Lordosis, measured between L1 and S1, changed from 56 degrees to 45 degrees. Transient neurologic deficit was seen in one case after vertebral decancellation. Staged surgery including vertebral decancellation is an effective surgical method for patients with severe scoliosis, where an inflexible rigid curve or the risk of occurrence of neurologic complications due to temporary correction may exist.

The complexity of tracheal intubation using rigid fiberoptic laryngoscopy (WuScope).

The complexity of tracheal intubation using rigid fiberoptic laryngoscopy (WuScope).

The Complexity of Tracheal Intubation Using Rigid Fiberoptic Laryngoscopy (WuScope)

The Complexity of Tracheal Intubation Using Rigid Fiberoptic Laryngoscopy (WuScope)

Adjustable Ring for Halo Traction Set Recalled Due to Possible Loose-Fitting Bolts

Adjustable Ring for Halo Traction Set Recalled Due to Possible Loose-Fitting Bolts

Osteomyelitis of calvarium after trivial scalp laceration.

A 16 year old girl had been swimming in the River Trent where she sustained a cut to her forehead after diving in. Within two days there was diffuse swelling...

Halo skeletal traction pin site care: toward developing a standard of care

Halo skeletal traction may be used to immobilize a patient's head and neck following a cervical fracture. Prevention of infectious reactions around the pin sites of halo traction is a priority in rehabilitation nursing practice. Although prophylactic treatment of skeletal pin sites is a generally accepted practice, there is great diversity of opinion and very limited systematic investigation as to how the sites should be treated. In this article, the author reviews the literature on pin site care and suggests a protocol based on the current literature.

Halo Skeletal Traction Pin Site Care: Toward Developing a Standard of Care

Halo skeletal traction may be used to immobilize a patient's head and neck following a cervical fracture. Prevention of infectious reactions around the pin sites of halo traction is a priority in rehabilitation nursing practice. Although prophylactic treatment of skeletal pin sites is a generally accepted practice, there is great diversity of opinion and very limited systematic investigation as to how the sites should be treated. In this article, the author reviews the literature on pin site care and suggests a protocol based on the current literature.

Spinal Deformity and Axial Traction

Axial traction to correct spinal deformity is a very old concept. The oldest reference available is in ancient Hindu mythological epics (written between 3500 BC and 1800 BC) where it is mentioned how Lord Krishna corrected the hunchback of one of his devotees. Later, Hippocrates (460 BC to 377 BC) described certain devices. Galen (131 AD to 201 AD), a follower of Hippocrates, used axial traction with direct pressure. Ibn Sena (980 AD to 1037 AD) in the Middle East also used similar methods. Osteopaths of Turkey also used axial traction to correct spinal deformities. But gradually mechanical methods for the correction of the spinal deformity went into disrepute due to the invariable production of paraplegia. In the past few decades, interest in the correction of spinal deformity has been rejuvenated due to better understanding of anatomy, physiology, and pathomechanics of spinal deformity. Controlled axial traction has been the keystone of several modern procedures such as Cotrel traction, Halo traction, and Harrington Outrigger instrumentation, etc. It appears that the primitive ways of application of axial traction by crude methods did not totally vanish but have been modified. In Indian tribal areas, bone setters still practice it in modified form.

Living with halo traction: A ‘survival’ guide for clients in halo traction

The author is an occupational therapist who, as a result of a motor car accident, spent 11 weeks in halo traction. During this period a guide to living in halo traction was written. The guide addressed strategies for managing neck and shoulder pain, sleeping, hair cleanliness, pain in the pin sites, pin site dressings, cleaning under the jacket and general pain. Positive feedback on the brochure has demonstrated its value to other patients. It is presented here for occupational therapists so that they may copy and distribute it to orthopaedic clients who are in halo traction.

Cervical spine injuries in the elderly

We reviewed 41 patients over the age of 65 years (mean 76.5) who had suffered cervical spine injuries, 12 of them with neurological deficit. Eleven patients died during treatment, mostly from respiratory disease. Seven patients were treated by surgical stabilisation, five by halo traction, and the rest by rigid collars or halo-vests. The cervical injury was missed at the first examination in four patients. We conclude that most injuries can be treated by a rigid collar, and that the use of a halo-vest or surgical stabilisation are effective alternatives. Bed rest and traction are poorly tolerated by old people. There should be a high index of suspicion that any elderly patient who presents with a history of a fall or minor trauma may have a cervical spine injury.

TRAUMATIC ATLANTOAXIAL DISTRACTIVE INSTABILITY

We present an uncommon case of traumatic atlantoaxial distractive instability which manifested itself clinically in a respirator-dependent quadriplegic. The initial radiographic finding was anterior atlantoaxial dislocation. The patient was managed initially by halo traction and, 8 weeks later, demonstrated occipitocervical fusion with gratifying results.

Eosinophilic granuloma of C5 causing cervical cord compression

A 2-year-old girl suffering from eosinophilic granuloma of the body of C5 presented with subluxation of C5 on C6 and neurological impairment due to cervical cord compression. Following a diagnostic percutaneous biopsy, the child was managed conservatively with halo traction for 9 weeks and recovered successfully.